Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

Patients, Doctors And Informed Medical Decision Making

You can’t be well-empowered if you hear advice wrong. That’s why in a participatory relationship, an essential skill is accurate handoff of information.

The Foundation for Informed Medical Decision Making (FIMDM), catchily pronounced “fimdim,” has been working for years to improve patients’ knowledge of options and alternatives. In [the September 20th] Boston Globe Liz Cooney talks with people from FIMDM about the issue. An excerpt:

What doctors explain and what patients understand might be two very different things, recent research suggests.

Ideally, patients talk with their doctors about the pros and cons of a particular treatment, weighing the risks and benefits, exploring alternatives — including doing nothing — and then come to a conclusion. That’s the goal of the informed consent process, best known by the paperwork patients sign at the end saying they heard doctors describe what they may be getting into.

If only it were that simple.

[This] article springboards off Cooney’s piece two weeks ago on heart stents, reported here by Dr. John Grohol as Doctors Say One Thing, Patients Hear Another.

A Boston non-profit, FIMDM is the force behind Gary Schwitzer’s excellent Health News Review service, which analyzes health news in the media, teaching e-patients and policy people to sift the gold from the garbage.

*This blog post was originally published at e-Patients.net*

Health “Care” Not Health “Performance”

The “empowered patient” movement (which I think is a good thing) strives to take the doctor out of the center of care and put the patient at its focus. The role of doctor is not to be the star of the show, the quarterback, the superhero, but the advocate and helper for the patient to accomplish their goal: Health.

Many rightly attack doctor prima donnas who want the exam/operating room to be about them instead of the patient. This is health care, not health performance. They want doctors who care more about the people they treat than they do about money, praise, or status.

I get it. I get the message that doctors have to adjust to this new age of patient empowerment and patient-centeredness. I get the fact that making patients wait is a bad thing, and that communication is as essential of a skill as is medical knowledge — remove either one of them and you don’t have care. I hear the message: Doctors should care about patients more than they care about themselves. That is what we are paid to do, and that is what we have neglected at our own peril. Read more »

*This blog post was originally published at Musings of a Distractible Mind*

To Change Patient Behavior, Change How You Talk To Them

According to Marshall Becker, PhD, MPH, a one-time professor of mine and prime mover behind the Health Belief Model (HBM), four things must be in place for health behavior change to occur. I am paraphrasing here: 

  1. A person has to know that they have a particular health condition.
  2. A person has to believe that having said health condition is bad.
  3. A person must perceive the benefits of behavior change to outweigh the difficulties of behavior change.
  4. There must be a “call to action” to spark the change.

Absent any one of these steps and the likelihood that behavior change will occur is diminished. Read more »

*This blog post was originally published at Mind The Gap*

Medical Errors: Discuss Them Or Switch Doctors?

Patients won’t confront doctors if they think there’s been a mistake. They’ll just find a new doctor, even if there’d been no medical error.

Researchers looked at adult visits to seven primary care practices in North Carolina during 2008. They asked patients about their perceptions of medical mistakes and how did it influence the choice to switch doctors.

Of 1,697 patients, 265 (15.6 percent) reported a mistake had been made, 227 (13.4 percent) reported a wrong diagnosis, 212 (12.5 percent) reported a wrong treatment, and 239 (14.1 percent) reported changing doctors as a result. Results appeared in the Archives of Internal Medicine.

But anecdotes cited by patients as mistakes were often normal diagnostic or therapeutic challenges. A typical scenario might be the patient reported symptoms, the doctor did not correctly diagnose it at first presentation, and a specialist or second physician offered a specific diagnosis. Other scenarios included medication trials or side effects from the prescription. Read more »

*This blog post was originally published at ACP Internist*

5 Reasons Why People Don’t Ask Their Doctor Questions

A neighbor of mine was diagnosed with breast cancer about the same time my wife was being treated for lung cancer. I saw my neighbor the other day for the first time in several years. I asked her how she was doing. She said great. In turn I asked her how her PET/CT exam looked. PET/CT scans are often done to make sure that one’s cancer hasn’t spread. My wife gets one every year.

My neighbor told me her doctor never told her she needed one, that mammograms would suffice. She went on to say a friend had also recently asked her if she had a PET/CT as well. “Maybe I should ask my doctor,” she told me. That was the same response she gave me the last time I raised the subject two years earlier: “I should ask my doctor.”
 
So Why Don’t People Ask More Questions?
 
My neighbor is not alone when it comes to asking their doctor questions. In an earlier post, I cited research which found that patients ask their doctor an average of two important questions during the office visit. According to researchers, there are five reasons why people don’t ask their doctor questions. Read more »

*This blog post was originally published at Mind The Gap*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »

Commented - Most Popular Articles